title: Topical treatment for phimosis: time span and other factors behind treatment effectiveness.
abstract: OBJECTIVE
  To study the factors that may influence the effectiveness of 0.2% betamethasone/hyaluronidase cream in the treatment of phimosis.
  
  
  METHODS
  We treated 427 patients (3-10 years old, mean 6.33) in a prospective, randomized, blind study, with 214 patients on a 4-week and 213 patients on an 8-week course. All patients were seen once monthly at least for 6 months after the end of treatment. The penis was photographed to allow objective evaluation of treatment response. The therapeutic response was graded as total success when there was complete exposure of the glans; partial success when there was exposure of half of the glans, impeded by balanopreputial adherence or ring fibrosis at the prepuce; and therapeutic failure when patients had no or less than 50% glans exposure.
  
  
  RESULTS
  After treatment 92.1% of patients showed total or partial success, but during follow up (mean 9.36 months, range 6-13) 29.5% failed to maintain this (22.6% and 37.6% for 8- and 4-week treatment, respectively). During treatment, 13.6% presented side effects or complications: prepuce ardor (6.1%), hyperemia (4.6%), paraphimosis (0.0098%). Intervention or interruption of treatment was unnecessary. The two groups were statistically similar in all parameters, but time of treatment=8 weeks, previous urethral meatal exposure and no previous balanoposthitis increased the chance of total success. Surgery was indicated for failure or relapse in 181 patients (42.38%).
  
  
  CONCLUSIONS
  Treatment with topical 0.2% betamethasone/hyaluronidase cream for 8 weeks is effective and safe, especially if the urethral meatus is exposed and there is no previous balanoposthitis. Rescue treatment is not recommended, as the results were not encouraging.
authors.affiliation: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Garcia de Freitas
authors.forename: Yuri Dantas
authors.initials: YD
authors.lastname: Nobre
authors.forename: Guilherme T S
authors.initials: GT
authors.lastname: Demarchi
authors.forename: Maurício
authors.initials: M
authors.lastname: Hachul
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz